Healthcare Provider Details

I. General information

NPI: 1386627818
Provider Name (Legal Business Name): BOLTON HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S FRAZIER ST SUITE 205
CONROE TX
77301-4400
US

IV. Provider business mailing address

PO BOX 841
ELKHART TX
75839-0841
US

V. Phone/Fax

Practice location:
  • Phone: 936-828-3739
  • Fax: 936-828-3741
Mailing address:
  • Phone: 904-764-0033
  • Fax: 903-764-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number012073
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1810244-03
License Number StateTX

VIII. Authorized Official

Name: MR. ROY H. BOLTON
Title or Position: PRESIDENT
Credential: RN
Phone: 903-764-0033